I am often asked by the men visiting my surgery, (and even more often by their wives), about prostate cancer.
It is the most common cancer that affects our New Zealand men yet the merest mention of getting tested seems to make even the most brave-hearted a little wobbly at the knees.
So how important is it to get checked, what does it entail, when should you start and how often do you need to go?
In New Zealand, about 2500 new cases of prostate cancer are diagnosed each year. The vast majority of these are in older men, largely over 65. However, it can occur at any age, and can be very aggressive in younger men. You are more at risk if a member of your family has had prostate cancer, especially if they were diagnosed at a young age.
Statistics from the United States show that if your father or brother was affected, you are more than twice as likely to develop the disease.
The speed of growth, or progression, of this type of cancer varies hugely between individuals - many older men who have a slow-growing form will live for many years, and usually die from other causes.
Sadly, more aggressive types can rapidly grow and spread to other parts of the body, especially the bones. These cases are especially important to pick up and treat early.
Not everyone with prostate cancer, especially in the early stages, will have symptoms. However, the following symptoms may indicate a prostate problem (not necessarily cancer) and should prompt a visit to your doctor
- Poor or reduced flow of urine.
- Needing to pass urine at night, often several times.
- Trouble starting or stopping urination, which may cause dribbling.
If you don't have any symptoms, it is still important to talk to your health professional about if and when you should get screened. This is a complex and personal question, and unfortunately there is not a one-size-fits-all answer.
If you have a family history, it is important to start screening early - by 40, if your relative was diagnosed under 55 years of age. If you don't, and you haven't experienced any symptoms, the jury is still out as to the best time.
Wellington urologist Rod Studd explains that studies have indicated that one or two prostate tests in your forties can give a "prediction" of your future risk, which is an appealing option.
Regular screening (every four years) is proven to be of benefit in the 55-69 year old group, but is likely to be beneficial for younger men as well.
Some men will weigh up the risks and side effects of treatment, against the benefit of having a possibly slow-growing cancer detected early, and opt out of testing completely.
So what does the test entail?
Firstly, you will be offered a blood test. This tests for Prostate Specific Antigen (or PSA). An increase in your PSA might indicate prostate cancer, but don't be alarmed as prostatitis (inflammation or infection of the prostate) and benign enlargement of the prostate (BPH) may also affect this result.
More testing including a biopsy or sample from the prostate gland itself will help to clarify things. The other test your doctor will discuss with you is a digital rectal examination (or DRE) - definitely something I suspect most men don't relish. By inserting a finger into the anus, it is possible to assess the size, shape and firmness of the prostate.
In a routine "screen", the DRE is usually combined with the PSA test.
However, the good news is that this may not necessarily be essential. Studies performed recently have used the blood test only, and have come out with impressive results.
Your doctor may recommend regular blood tests, ranging from every one to five years. This is to check the rate of change of your PSA level.
Timeframes mentioned here don't apply to anyone with symptoms - if that is you, or your loved one, you really need to bite the bullet and pick up the phone today.
- Cathy Stephenson is a general practitioner, medical forensic examiner and mother of three. If you have a question for her, email email@example.com
- © Fairfax NZ News
Is John Banks' upcoming trial the end for the ACT party?Related story: Banks takes only viable option